PDCA循环在医院医保总额控制付费方式下的应用  

Application of PDCA in hospital medical insurance total control payment

作　　者：张芬[1] 陈莉[1] 汤永红 ZHANG Feng;CHEN Li;TANG Yonghong(Affiliated Nahua Hospital,University of South China,Hengyang 421002,China;不详)

机构地区：[1]南华大学附属南华医院,湖南衡阳421002

出　　处：《现代医院》2020年第7期1003-1006,共4页Modern Hospitals

摘　　要：目的探讨PDCA循环管理模式应用在医院医保总额控制付费方式下管理中的价值。方法建立医院医保管理体系,与2017年1月—12月在全院各科室、各控费管理环节中实施PDCA循环,进行医保管理规划、修订和实施及循环与改进后的各项数据指标的对照,并进行统计学处理。结果PDCA循环医保管理模式后医务人员对医保政策知晓度、患者对医保咨询的满意度提高,P<0.05;医保各指标完成明显提高,医保违规条目明显减少。结论实施基于PDCA循环的医院医保管理模式可提高医保服务质量,并可更好的控制医保费用,维护消费者的权益。Objective To explore the value of PDCA Cycle management model in the management of hospital medical insurance total control payment.Methods The medical insurance management system was established,and PDCA cycle was implemented in all departments and fee control management links in the whole hospital from January 2017 to December 2017 to carry out the control of all data indexes after medical insurance management plan,revision,implementation,circulation and improvement,and the statistics processing was carried out.Results After the application of the PDCA cycle medical insurance management model,the degree of knowledge of medical staff on medical insurance policy and patients’satisfaction with medical insurance consultation were improved(P<0.05).The medical insurance indexes were improved obviously,and the medical malpractice clauses decreased obviously.Conclusion The implementation of hospital medical insurance management model based on PDCA cycle can improve the quality of medical insurance service,and can better control the cost of medical insurance and protect the interests of consumers.

关 键 词：PDCA循环 医保总额控制付费 费用控制 

分 类 号：R197[医药卫生—卫生事业管理]